Organization: UN Children’s Fund
Closing date: 05 Apr 2018
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. To save their lives. To defend their rights. To help them fulfill their potential.
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IMNCI – Integrated Management of Newborn and Childhood Illness
In the mid-1990s, Integrated Management of Childhood Illness (IMCI) was developed by WHO and UNICEF in efforts to reduce under five child mortality and morbidity from common childhood Illnesses and to promote healthy child growth and development for children under five in countries with high child mortality rates (>40 per 1000 live births). Later, the care for newborns was added and the strategy was renamed as IMNCI. There are three main components to the IMNCI strategy: 1) improving health worker skills, 2) strengthening health systems and 3) improving family and community practices.
In 2000, Zimbabwe adopted the IMNCI strategy, managing in an integrated manner the six major diseases that cause 70% of all under five deaths in the country (pneumonia, malaria, measles, malnutrition, diarrhea and HIV/AIDS). The Ministry of Health and Child Care (MoHCC) set ambitious targets that at least 2 health workers at every health facility be trained in IMNCI. To date, the MOHCC has achieved 87.6% of health facilities with at least 1 IMNCI trained health worker and 49.8% of health facilities with at least 2 IMNCI trained health workers. The global recommendation is to have at least 60% of health workers providing care for sick children being trained in IMNCI.
Despite high coverage of IMNCI trained staff, the last 2 decades have witnessed the emergence of specific child health programmes and interventions which to some extent have weakened the overall approach of a holistic view of child health and ensuring a continuum of care. At the same time, in Zimbabwe the IMNCI strategy has undergone many changes with respect to its training and implementation modalities. At present, the training module has been reduced to 6 days with a focus on case management and a distance learning module has also been introduced. Prior to additional investments in the efforts to expand the strategy’s implementation, it is considered important to conduct an assessment to determine the effectiveness of the current model of IMNCI training, a blended case management approach and distance learning, in delivering the right skills and level of application of skills by trained health workers.
IMAM – Integrated Management of Acute Malnutrition
The Integrated Management of Acute Malnutrition (IMAM) program key outcome indicators of cure and defaulter rates in Zimbabwe have not met sphere targets over the last three years. This is despite various emergency response programs funded by donors over the period 2015 to 2017. In total, 42 out of 63 districts have received IMAM trainings using updated Outpatient Therapeutic Program (OTP) guidelines since 2015. Yet cure rate, though on the upward trend, has remained off target. Defaulter rates have been marginally off target and generally very high in some specific areas. As of January 2018; The overall cure rate was 67%, which is slightly off the sphere target of >=75%. The average defaulter rate was 16.1%, which is slightly above the global threshold of 15%. Preliminary observations through routine supportive supervision also indicated that there were challenges of poor documentation (including under reporting) and misclassification of outcomes. Gaps and discrepancies were also observed in data capturing; with DHIS2 and active screening records not matching. There are thus major issues with quality assurance of the nutrition program. Assessing the capacity building methods and extent of adherence to OTP guidelines in IMAM program implementation by all relevant parties will hopefully give an insight on how to best improve quality of IMAM service delivery.
ETAT – Emergency Triage and Treatment
WHO developed guidelines for Emergency Triage and Treatment in 2005, and these were shown to improve quality of emergency care and reduced early mortality in hospitals in Africa. Zimbabwe adopted the ETAT approach training in 2015. ETAT targets health workers who offer emergency care of sick children in hospitals (pediatricians, general medical officers, pediatric nurses and nurses working in pediatric outpatients). Training materials were adapted and adopted from the WHO ETAT course and the Kenyan ETAT plus admission care of newborns and children within the first 48 hours, in collaboration with the Paediatric Association of Zimbabwe. To date ETAT training workshops have been conducted in the Central Hospitals (Parirenyatwa, HCH, Chitungwiza and Mpilo) and in six of the rural provinces. While ETAT is seen as an important course, resources have been decreasing to support this training course.
In summary, the three above mentioned trainings are at different stages of implementation and yet similar issues around skill application are evident. The current assessment aims to provide data that the training approaches of these 3 interventions is optimal and in fact yield desired results in manner that is cost effective.
Assess the effectiveness of the current model of IMNCI, ETAT and IMAM training in delivering the right skills and level of application of skills by trained health workers
It is anticipated that the assessment will:
Objectives & Justification
The principal objective of this assignment is two-fold:
Crosscutting research questions
What are the opportunities for integration, harmonization and synergies across the different programmes
Specific research questions for IMNCI are:
Specific research questions for IMAM are:
what extent do health workers adhere to the existing IMAM guidelines and standard case
definitions for classification and reporting treatment outcomes?
Specific research questions for ETAT are:
The consultant/multi-disciplinary team will work closely with the Ministry of Health and Child Care’s Child Survival Technical Working Group, which will orient, guide and validate the assessment.
Major tasks and Deliverables
Desk review of key national child health strategies and protocols, health information system data trends, training reports and other relevant resources/references
Inception report and Situational analysis report
Hold discussions with key stakeholders at national, provincial and district levels
Stakeholder consultations reports
Develop/design assessment concept, plan and collection and analysis tools
Concept note and data analysis tools
Implementation of assessment in the field
Field work report
Data analysis and presentation of findings
Presentation of findings
Assessment write up & restitution of results to stakeholders
Final assessment report
The consultant is expected to work for a total of thirty (30) days over a period of two (2) months. While the period for the development of the NCBHS document has been defined, the specific timelines for the development of the various components will be developed by the TWG considering the advice of the consultant. Based on the agreement, the consultant will develop his/her workplan indicating the different types of support to be provided at different stages.
The consultancy will begin on 9th April 2018 and end not later than 9th June 2018.
Should hold a relevant Masters in Public Health or Pediatrics, Child health
Strong writing and presentation skills
The consultant should have experience/knowledge and expertise on IMNCI, ETAT and IMAM
If interested and available, please submit your application letter, CV, Technical and an all-inclusive financial proposal detailing monthly professional fees, 5 field travel days outside Harare per month and other miscellaneous expenses
UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified candidates from all backgrounds to apply.
How to apply:
UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organization. To apply, click on the following link http://www.unicef.org/about/employ/?job=511878
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